Implantable Cardiac Defibrilllator (ICD)

Prep the patients abdomen, chest, and leg making sure to expose enough area to place a subcutaneous coil.
Obtain venous access below the inguinal ligament with a single 0.035 wire on the right side.
Make a small incision over the inguinal ligament.
Obtain access to the ileo-femoral vein aiming the Cook needle at the wire at a steep angle.
Use a long 7F St Jude (DI-Lock) 23 cm peel away sheath over the wire.
Make abdominal pocket early in case to insure hemostasis is obtained.
Place a 100 cm Medtronic ICD lead in the RV and RA. The RA stylet will need a gentle curve. Use both tie down sleeves in the inguinal pocket.
Tunnel up to the abdominal pocket with hemostats or tunneling tool.
Use a penrose (1/4 to 1/2 inch) to pull the leads through to the abdominal pocket which is placed above the belt line.
If needed for high DFTs place SQ coil through abdominal incision.
May need a Medtronic device so you can turn the can off if needed.
If a subcutaneous coil is used Y adapt it to the right atrial lead.
Obtain follow CXR and KUB.